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<br /> ELECTRICAL PE PPLICAT]I� N
<br /> r CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 ( FAX 425-257-8857 1 (E)everetteps@everettwa.gov i www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: .511,-al
<br /> BUILDING AREA(if residential,new construction,remade,or addition) SF
<br /> BUILDING TYPE: D SFR-DETACHED` ' D SFR-ATTACHED D DUPLEX El MULTI-FAMILY-4 OF UNITS: )4 COMMERCIAL
<br /> USE OF BUILDING: ©ETI 6 EVEELTI
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<br /> CONTRACT PRICE OF WORK:$ 10 77
<br /> NUMBER OF DEVICES(if low voltage): !
<br /> FIRE ALARM? D YES 14 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: '4/3/923E/5J D., •-- 1
<br /> /4171AVAd .01d-r
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<br /> OWNER NAME: TENANT NAME(If Commercial): //J6
<br /> OWNER MAILING ADDRESS: swam- fQ ,?)( 3707
<br /> err' 5EA TLE STATE IA4 z!tf l/2Y-2207
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: geiVerA'L �j05] !_ e,'7'0/(..J
<br /> CONTRACTOR ADDRESS: sraaer Pa BOX 41p 1
<br /> coYhia,KIL.—[- STAT I�/i!�Q
<br /> ZIP9sza4
<br /> CONTRACTOR PHONE:426-2,94-6144-6Gl944 CONTRACTOR EMAIL: k4 e f. �/; �rJQ , -wi '� eo'n
<br /> CONFRACTORLIC,#(REQU1REp}: L7�rV( !� '�D z CITY OF EVTrRETT DUSINESS LIC. (REQUIRED):0/405
<br /> PRIMARY CONTACT: El OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: p I CONTACT PHONE: 206-736-6544!
<br /> 1�IV'413 640W CONTACT EMAIL: DEN J!lg.�1�oks ® Ks tilt 1 T. (LDM
<br /> AGREEMENT:T hereby certify that t have read and examined this application and knowiha same to be true and correct. All provisions ofJaws and ordinances governing this
<br /> type of workwlllbe completed whether specified herein or not The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made and 1
<br /> comply with the Slate Contractors Law 1s 27fCWand 298.200 WAG.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> ,36 5P
<br /> PERMIT�/ ---/9-4 E k � -
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<br /> Owner/Au or zed Agen Signature Date (Revised 10/12/2015)
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